Debono, D and Taylor, N and Lipworth, W and Greenfield, D and Travaglia, J and Black, D and Braithwaite, J, Applying the theoretical domains framework to identify barriers and targeted interventions to enhance nurses' use of electronic medication management systems in two Australian hospitals, Implementation Science, 12 Article 42. ISSN 1748-5908 (2017) [Refereed Article]
Copyright 2017 The Authors. Licensed under Creative Commons Attribution 4.0 International (CC BY 4.0) https://creativecommons.org/licenses/by/4.0/
Background: Medication errors harm hospitalised patients and increase health care costs. Electronic Medication Management Systems (EMMS) have been shown to reduce medication errors. However, nurses do not always use EMMS as intended, largely because implementation of such patient safety strategies requires clinicians to change their existing practices, routines and behaviour. This study uses the Theoretical Domains Framework (TDF) to identify barriers and targeted interventions to enhance nursesí appropriate use of EMMS in two Australian hospitals.
Methods: This qualitative study draws on in-depth interviews with 19 acute care nurses who used EMMS. A convenience sampling approach was used. Nurses working on the study units (N = 6) in two hospitals were invited to participate if available during the data collection period. Interviews inductively explored nursesí experiences of using EMMS (step 1). Data were analysed using the TDF to identify theory-derived barriers to nursesí appropriate use of EMMS (step 2). Relevant behaviour change techniques (BCTs) were identified to overcome key barriers to using EMMS (step 3) followed by the identification of potential literature-informed targeted intervention strategies to operationalise the identified BCTs (step 4).
Results: Barriers to nursesí use of EMMS in acute care were represented by nine domains of the TDF. Two closely linked domains emerged as major barriers to EMMS use: Environmental Context and Resources (availability and properties of computers on wheels (COWs); technology characteristics; specific contexts; competing demands and time pressure) and Social/Professional Role and Identity (conflict between using EMMS appropriately and executing behaviours critical to nursesí professional role and identity). The study identified three potential BCTs to address the Environmental Context and Resources domain barrier: adding objects to the environment; restructuring the physical environment; and prompts and cues. Seven BCTs to address Social/Professional Role and Identity were identified: social process of encouragement; pressure or support; information about othersí approval; incompatible beliefs; identification of self as role model; framing/reframing; social comparison; and demonstration of behaviour. It proposes several targeted interventions to deliver these BCTs.
Conclusions: The TDF provides a useful approach to identify barriers to nursesí prescribed use of EMMS, and can inform the design of targeted theory-based interventions to improve EMMS implementation.
|Item Type:||Refereed Article|
|Keywords:||implementation, theoretical domains framework, behaviour change, electronic medication management systems, medication administration, workarounds|
|Research Division:||Medical and Health Sciences|
|Research Group:||Public Health and Health Services|
|Research Field:||Health Information Systems (incl. Surveillance)|
|Objective Group:||Health and Support Services|
|Objective Field:||Health and Support Services not elsewhere classified|
|UTAS Author:||Greenfield, D (Professor David Greenfield)|
|Web of Science® Times Cited:||10|
|Downloads:||77 View Download Statistics|
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